Research & Information

Substance Use Disorders

About

A substance can be anything that is ingested in order to produce
a high, alter one's senses, or otherwise affect mood, perception
and consciousness.

Substance use can be common in young people, and individuals
have different patterns of use (bingeing, occasional or continual)
and reasons for use (for example as an 'experiment', for 'fun' or
to 'escape', to 'join in' with peers, or to get through a certain
situation- such as the desire to stay awake). Where use is
prolonged, heavy, or creating social or personal problems it may
meet a 'diagnosis' for a substance use disorder: substance
dependence or substance abuse (1).

In substance abuse a person experiences harmful changes in their
behaviour as a result of repeatedly using a substance, that
negatively affects their work/school responsibilities, social
relationships, and can lead to increased risk taking and other
personal or social problems. In substance dependence, a person
relies on a substance despite the problems caused by continuing its
use. In addition to the social and personal problems of substance
abuse, dependence leads also to cognitive, behavioural and physical
symptoms if a person continues using.

Burden and onset of substance use disorders in young
people

Substance use is common among young people, and alcohol is the
most common substance used by youth. A survey of Australian
secondary students aged between 12 and 17 years, found that 80
percent had tried alcohol, 14 percent had used cannabis, and 19
percent had used inhalants at some time in their lives (2).

People with substance use disorders often don't recognise or
seek help for the problem, and may not be screened for substance
abuse when they seek treatment for other health conditions, which
means that substance abuse and dependence disorders are often
under-recognised and undertreated. Despite this, substance use
disorders are among the most common of mental health disorders
experienced by young people. In Australia, 12.7 percent of people
aged 16-24 are estimated to have a substance use disorder, with
higher rates among young men than young women (around 16% of males
and 10% of females) (3). Harmful use of alcohol
was the most commonly reported substance use disorder (at around
9%) (4).

Overall, about half of people with substance use disorders first
experience substance use issues by the age of 20 (5). Substance use disorders in younger
adolescents are most commonly harmful use or abuse; substance
dependence remains less common until later in adolescence/early
adulthood (5, 6).

Substance use disorders can result in significant short and
long-term ill effects. These consequences arise from the type of
substance and the way it is used (for example, respiratory problems
resulting from smoking and spread of infections such as Hepatitis
via injecting); from the immediate effects of intoxication (such as
overdose, traffic accidents and falls, risky sexual behaviour,
violence and aggression); from the longer terms physical effect of
the drug (such as brain damage, liver disease, cancer) and the
significant mental distress caused associated with drug dependence
(7).

There is a close relationship between substance use disorders
and other mental disorders, and use of some substances may increase
the risk of developing certain disorders, however it is often
unclear whether one issue causes the other. It is common for young
people with substance use issue to have one or more co occurring
mental health disorders, such as anxiety, depression and
schizophrenia(8).

Risk factors
A number of factors can increase the likelihood that a person
will have a substance use disorder (9-11).
They include the following:

Related to the individual:

Possible genetic predisposition (eg. a substance use disorder
in another family member)

A diagnosis of Substance Abuse is based on a 12-month pattern of
substance use leading to significant impairment in functioning,
demonstrated by at least one of the following:

An inability to fulfill responsibilities at home, at work, or
when studying

Repeatedly using substances when it is physically dangerous,
for example when driving a vehicle

Legal problems of many different types as a result of
short-term intoxication or longer-term cognitive effects on
behavior, or arising the desire to obtain more of the substance
they are dependant on

Recurring personal or social problems.

A diagnosis of dependence may be made when symptoms of substance
abuse are present, along with:

Increased tolerance (requiring higher doses to achieve the same
effect)

Withdrawal symptoms when use is stopped

Compulsive substance-taking behaviour.

Assessment Tools
There is not a common list of symptoms that can be used to tell if
someone is misusing drugs, as different drugs have different
affects on different people. To decide whether a young person may
be experiencing a substance use disorder, a comprehensive
assessment in required. Assessing substance use is also important
when someone is presenting for other issues (such as mental health
issues). Assessment involves asking questions about a range of
aspects of a person's life including substance use and their:

A comprehensive assessment would include questions to find out
the types of substances used and method of ingestion (ie inhaled,
injected, etc), the frequency and duration of use and the age of
first use.

Most research about interventions for reducing substance abuse
among young people focuses on approaches to prevent substance use.
Less is known about the best methods to treat a substance use
disorder once it is established.

Approaches that have some benefit in preventing young people's
use of drugs in general include motivational interviewing and some
family interventions (1); for illicit drugs,
skills based school programs (2); and for alcohol
use specifically- the Strengthening Families Programme and
culturally focused skills training appear to offer promise (3).

Treatment options that have been demonstrated to be effective or
promising include cognitive behaviour therapy (4), multidimensional family therapy, functional
family therapy, and group CBT (5, 6), contingency management and brief interventions
like motivational interviewing (although with only small
effects)(7-9). Family behavior therapy and
individual cognitive problem-solving therapy are effective
approaches for young people with a dual diagnosis (10). In general, psychosocial treatment is more
effective than no treatment, although there are some approaches
that have been found to have negative effects. Overall, little is
known about the effectiveness of using medications to treat
substance use disorders in young people (11).

Even when an individual does not meet full criteria for a
substance abuse related diagnosis, they may benefit from support to
reduce the amount of their substance use.

The evidence
map provides reference details for studies of prevention and
treatment interventions for substance use disorders in young
people.

We acknowledge that headspace is in a unique position in the Australian youth space and recognise that we can make a positive contribution to the lives of young people. As our small contribution to Indigenous reconciliation and reducing racism and other forms of discrimination - we acknowledge, the wise people of our Indigenous communities, past and present who are the foundations of this great country of ours. We acknowledge that we share this land with the traditional owners and custodians.